New research finds UK medical students are missing out on comprehensive abortion care education, due to multiple barriers preventing effective teaching.
The researchers discovered that the lack of abortion care education and barriers to effective teaching was coupled with highly variable curriculum provision. Abortion is a common procedure to terminate a pregnancy, which highlights how fundamental comprehensive education on abortion care is for future doctors.
The team of researchers noted that whatever a doctor’s personal cultural or religious beliefs, all doctors need to know about the clinical complications of abortions so they can treat patients effectively in an emergency.
The new research was published online in BMJ Sexual & Reproductive Health.
Educating next-generation doctors on abortion care
One in three women in the UK will have an abortion before the age of 45. This highlights the importance of abortion care education, and several medical bodies emphasise this fact, including the Royal College of Obstetricians and Gynaecologists, the Institute for Medical Ethics, and the National Institute for Health and Care Excellence (NICE).
Due to the complexity surrounding the legal history in all four UK nations, and the attendant ethical issues, the researchers wanted to find out the extent to which abortion care is included in the medical school curriculum and the scope of the ethical-legal and clinical aspects of abortion teaching.
Scientists sent two separate surveys to ethics leads and clinical curriculum leads in obstetrics and gynaecology, sexual health, and women’s health at 33 UK medical schools that were publicly funded as of February 2019.
The surveys were similar in structure, and both included time spent on teaching abortion, teaching methods, content, assessment, barriers to teaching, and desire for further guidance on teaching abortion care.
In total, 25 medical schools responded to at least one survey with six schools responding to both. 40% (13/32) of clinical surveys and 55% (18/33) of ethical-legal surveys were completed.
Survey results from UK medical schools
All ethical-legal survey respondents said that their medical school provided compulsory education on ethical and legal aspects of abortion care. However, this was not the case for clinical survey respondents, although most (85%) stated that teaching the clinical aspects of abortion care was compulsory.
One medical school provided optional clinical education, and one respondent stated that they did not provide any clinical education as the procedure was illegal in their location (Northern Ireland) at that time.
The number of hours spent on abortion teaching varied widely, ranging from less than one hour to more than eight on ethical-legal aspects, and under one hour up to five-six hours on clinical aspects.
A period of one-two hours was the most commonly cited in each of the surveys: nine (50%) ethical-legal respondents; six (46%) clinical respondents.
The surveys found that lectures were the most popular teaching method and multiple-choice questions were common for assessment types.
Some medical schools also assessed ethical and legal aspects of abortion in objective structured clinical examinations. But only around a third (31%; 4/13) of clinical leads indicated that abortion was included in clinical assessments.
“Students often establish the importance of a topic based on its value in assessments: if it is not assessed, it is deemed to be less important. This may also have negative implications for future service provision, as medical student exposure to a subject influences their career choices in later years,” noted the researchers.
Topics covered in clinical teaching were inconsistent among medical schools, however, with no single topic covered by all of them.
“Worryingly, this is likely to produce significantly different abortion-related knowledge among graduates from different institutions,” warned scientists.
Furthermore, more than half (56%) of ethical-legal curriculum leads felt they experienced barriers to delivering abortion teaching, particularly insufficient curriculum time, and too few qualified or willing staff to teach it. Most (85%) clinical respondents also reported experiencing barriers to teaching. Nearly half (45%) felt that abortion was a sensitive topic and that this acted as a barrier while nearly one in five (18%) had ethical concerns about teaching abortion.
Around three out of four respondents to each survey wanted further guidance on how best to teach abortion care.